Firm-based trial to improve central venous catheter insertion practices.
Academic Article
Overview
abstract
BACKGROUND: Central venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein. OBJECTIVE: Determine whether a hands-on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control. DESIGN: Firm-based clinical trial between November 2004 and March 2005. SETTING: General medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital. PARTICIPANTS: Internal medicine residents (n = 150). INTERVENTION: Before their 4-week rotation, intervention-firm residents received a lecture and practiced placing catheters in mannequins; control-firm residents received the usual training. MEASUREMENTS: Venous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter-associated complications RESULTS: Residents inserted 54 catheters, or 0.24 insertions per resident per 4-week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: -14% (95% CI, -52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention-group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3-2.7), but other practices were similar. CONCLUSIONS: Our intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills-building session may have deteriorated given the few clinical opportunities for reinforcement.
